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Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method: One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results: The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion: These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. [ABSTRACT FROM AUTHOR]